NCPA: More Than 125 Groups Urge Congress to Pass PBM Reform

In a letter to Congress, the National Community Pharmacists Association (NCPA) addressed the need to pass the PBM Reform Act (H.R. 4317) and 2 companion bills: the Protecting Pharmacies in Medicaid Act (S. 927) and the Patients Before Middlemen Act (S. 882). Sent on behalf of 134 patient, payer, and provider groups, the letter was addressed to House and Senate leadership on Monday, according to an NCPA news release.¹

“All of these measures have bipartisan support in both houses,” Douglas Hoey, RPh, MBA, CEO of the NCPA, said in a news release. “Everyone in Washington sees what's happening and everyone outside the beltway is feeling the pain from PBM business practices.”

The PBM Reform Act was the focus of the NCPA’s letter to Congress. Designed to improve access and costs for patients and eliminate opaque PBM practices, the lawmakers who drafted it have long harped on the bill’s bipartisan support. Created by 11 Republican and Democrat congressmen, the sheer support from various health care organizations and representatives further underscores the full scope of the people and groups that want industry-wide change.^1,2

The letter addressed passing the PBM Reform Act (H.R. 4317), the Protecting Pharmacies in Medicaid Act (S. 927), and the Patients Before Middlemen Act (S. 882). | image credit: sornram / stock.adobe.com

READ MORE: How Real Patient Experiences Have Helped Bolster Advocacy for PBM Reform

Hoping to force immediate congressional action, the letter was addressed to House Speaker Mike Johnson (R, Louisiana), Senate Majority Leader John Thune (R, South Dakota), House Minority Leader Hakeem Jeffries (D, New York), and Senate Minority Leader Chuck Schumer (D, New York).

“The American public is tired of losing access to their local health care providers and of paying too much out-of-pocket for the medicines they need,” the groups said in their letter to Congress.³ “Pharmacists are some of the most accessible and trusted health care professionals in America, with patients—particularly in rural and underserved communities—reliant on their training and expertise.”

Bipartisan support on the Hill has been a key factor for hopes in passing PBM reform. However, as reinforced by the significant representation in the NCPA’s letter, health care organizations and patient advocates across the country are letting their calls for reform be heard. From the AIDS Drug Assistance Program Advocacy Association to the Wyoming Pharmacy Association, the letter garnered support from business groups, health care organizations, nonprofits, and even grocery stores and their advocacy groups.¹

While introduced in July of this year,² the PBM Reform Act was the focus of these groups’ letter. It also included calls to pass the Protecting Pharmacies in Medicaid Act and the Patients Before Middlemen Act.

These 2 laws are intended to serve as “companion bills,” as the NCPA stated, to the PBM Reform Act. Both of these companion bills have similar implications as the PBM Reform Act, but they are focused on specific PBM practices among Medicaid and Medicare Part D plans. Protecting Pharmacies in Medicaid will ban PBMs from spread pricing and force them to pass through the full amount of Medicaid reimbursement to pharmacies.⁴

The Patients Before Middlemen Act is more geared toward Medicare Part D drug plans, making PBMs relinquish the act of assessing direct and indirect remuneration (DIR) fees after the point of sale. Passing this law would delink PBMs and DIR fees, releasing a financial burden for pharmacies trying to dispense Medicare Part D drugs.⁵

“For too long, PBMs have been allowed to operate unchecked, raising prices and preventing many patients from getting the medications they depend on,” Representative Debbie Dingell (D, Michigan), co-sponsor of the PBM Reform Act, said.² “Their harmful, aggressive tactics are only getting worse, and we must take action now to protect pharmacies and lower patient costs.”

Through years of investigation into PBM practices, health care leaders and drug market experts have unveiled the immense profits the biggest PBMs have been able to yield. As the letter states, PBMs made over $7 billion from 2017 to 2022, while up to 33% of all retail pharmacies in the US have closed since 2010.¹

While the letter sent to Congress is not the first to urge for PBM reform—and it likely will not be the last—experts and constituents from both sides of the aisle, inside and outside of health care, have been calling for federal PBM reform. Steps toward reform, like advocating for congressional action and forming industry-wide coalitions, may show collective support for a shared change in the pharmacy benefits and prescription drug market. However, these actions have yet to result in notable federal reform.

“Everyone knows the PBMs are overcharging taxpayers, driving up drug prices, and reducing patient access to life-saving drugs,” concluded Hoey.¹ “We're very proud to have worked with all these groups to make it unmistakably clear to Congress that these reforms can be delayed no longer.”

READ MORE: Pharmacy Owners Say They Are Unable to Participate in MDPNP

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REFERENCES

1. NCPA leads huge coalition in letter asking Congress to pass PBM Reform Act. NCPA. News Release. September 8, 2025. Accessed September 9, 2025. https://ncpa.org/newsroom/news-releases/2025/09/08/ncpa-leads-huge-coalition-letter-asking-congress-pass-pbm-reform

2. Carter introduces bipartisan PBM reform package. The Office of United States Representative Buddy Carter. News Release. July 10, 2025. Accessed September 9, 2025. https://buddycarter.house.gov/news/documentsingle.aspx?DocumentID=15782

3. PBM Reform Act support letter. NCPA. September 8, 2025. Accessed September 9, 2025. https://www.ncpa.co/pdf/2025/advocacy/sept-2025-pbm-reform-act-support-letter.pdf

4. Protecting Pharmacies in Medicaid Act summary. Academy of Managed Care Pharmacy. Accessed September 9, 2025. https://www.amcp.org/letters-statements-analysis/protecting-pharmacies-medicaid-act-summary

5. Furgeson G. Patients Before Middlemen Act and potential impact. Frier Levitt. September 21, 2023. Accessed September 9, 2025. https://www.frierlevitt.com/articles/patients-before-middlemen-act-and-potential-impact/